title: Less morbidity after introduction of a new departmental policy for patients who undergo open distal pancreatectomy.
abstract: BACKGROUND
  The aim of this study was to retrospectively compare morbidity and mortality before and after introduction of a new departmental policy for patients who undergo distal pancreatectomy.
  
  
  METHODS
  We have introduced the use of an ultrasonically-activated device in distal pancreatectomy, an "early removal of drains" policy and perioperative management using a clinical pathway since May 2006. Group A consisted of 52 consecutive patients from 2000 to February 2006. Group B consisted of 57 consecutive patients from May 2006 to 2010.
  
  
  RESULTS
  Although there was no difference in the fluid collection rate within 30 postoperative days (Group A, 44% vs. Group B, 35%), the rates of intra-abdominal abscess (A, 19% vs. B, 4%) and grade 3/4 of the Clavien classification (A, 23% vs. B, 9%) in Group B were significantly lower than in Group A (P < 0.05). Time of drain removal (median 3 days vs. 8 days) and length of in-hospital stay (median 8 days vs. 17 days) in Group B were significantly shorter than in Group A (P < 0.001).
  
  
  CONCLUSIONS
  The implementation of new departmental guidelines for distal pancreatectomy was closely associated with a low frequency of intra-abdominal abscess and grade 3/4 Clavien score, resulting in a shorter in-hospital stay.
authors.affiliation: Department of Surgery, Kansai Medical University, 2-3-1 Shin-machi, Hirakata, Osaka, 573-1191, Japan.
authors.forename: Rintaro
authors.initials: R
authors.lastname: Yui
authors.forename: Sohei
authors.initials: S
authors.lastname: Satoi
authors.forename: Hideyoshi
authors.initials: H
authors.lastname: Toyokawa
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Yanagimoto
authors.forename: Tomohisa
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hirooka
authors.forename: So
authors.initials: S
authors.lastname: Yamaki
authors.forename: Hironori
authors.initials: H
authors.lastname: Ryota
authors.forename: Taku
authors.initials: T
authors.lastname: Michiura
authors.forename: Kentaro
authors.initials: K
authors.lastname: Inoue
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Matsui
authors.forename: A-Hon
authors.initials: AH
authors.lastname: Kwon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019091:Critical Pathways; D004322:Drainage; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010180:Pancreatectomy / Q000592:standards*; D019990:Perioperative Care; D011183:Postoperative Complications; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Clavien-Dindo classification; Distal pancreatectomy; Intra-abdominal abscess; Pancreatic fistula